Provider Demographics
NPI:1740344498
Name:EATON, GREGORY TODD (LCPC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:TODD
Last Name:EATON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W OGDEN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3179
Mailing Address - Country:US
Mailing Address - Phone:630-986-4260
Mailing Address - Fax:630-986-1477
Practice Address - Street 1:501 W OGDEN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3179
Practice Address - Country:US
Practice Address - Phone:630-986-4260
Practice Address - Fax:630-986-1477
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional